NPI | 1780682963 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MI 4301074605) |
Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: PA MD422257) |
Enumeration Date | 2005-07-12 |
Last Update Date | 2016-12-07 |